Health Assessment during Postpartum Period

1. Health Assessment during Postpartum Period by Assoc. Prof. Dr. Susanha Yimyam Faculty of Nursing, CMU

2. Principle • History, Physical Examination (Observation, Palpation, Listening), Laboratory, Special Examination • 4 Dimensions: Physical, Psychological, Social and Spiritual dimensions • 12 B • Overview: Background, Body conditions, Bodytemp& Blood pressure • Neck => Toe • Breast & Lactation, Belly & Uterus, Bladder, Bowel movement, • Bleeding & Lochia, Buttom • Blues • Baby • Bonding & Attachment

3. 1. Background • 1.1 Personal data • age, education, occupation, income • residence, culture, beliefs & value • supporting persons & networkin family & community • 1.2 Pregnancy history • Parity, childbearing, childrearing& complications • 1.3 Current pregnancy & childbirth • type &durationof labor • medications during labor & complication

4. 1. Background (cont.) 1.4 Postpartum data General health Maternal adaptation Ability of breastfeeding Supports from family & community 1.5 Laboratory & Special examinatio n 1.6 Family’s health history 1.7 Culture, health beliefs & value Self-care & infant care

5. 2. Body conditions 2.1 General Appearance,Manner, Clean & Comfort Weakness, Lift up from bed Abilities for routine activities o fnormal life 2.2 Anemia Conjunctiva, Nail,Hb & Hct 2.3 Lower extremity Color edema Varicose vein 2.4 Sleep pattern 2.5 Foods & water 2.6Readiness & demand to learn

6. 3. Body temperature & Blood pressure 3.1 Body temperature 24 hours of after birth Body temperation = / > 38 CInfection 3.2 Pulse 3.3 Blood pressure 24 hours of after birth=>Orthostatic hypotension => Postpartum Hemorrhage

7. 4. Breast & Lactation 4.1 Breasts Balance, Rash? Comfort, Breast engorgement? 4.2 Nipples Normal, Short, Invert, Crack ? Engorge areola ? Painful ? 4.3 Breast milk Milk production & lactation Quantity & Quality of breast milk

8. 5. Belly and Uterus 5.1 Abdomen Striae gravidarum, linea nigra Diastasis recti Rash, Scar 5.2 Uterus Contraction, Fundal height, Involution After (birth) pain

9. 6. Bladder 6.1 Full bladder 6.2 Urine 6.3 Urination Painfulduring urinationFrequency of urinationUrinary incontinence

10. 7.Bleeding & Lochia - continued serosa &alba lochia endometritis 7.1 Characteristic & Quantity Lochia rubra: 2-3 days after birth: darkled red, no blood clot Lochia serosa: 4-9days after birth:pink or brown Lochia alba: 10 days after birth:yellow or white/ cream - Lochia: heavy & with blood clotPostpartum hemorrhage - Lochiarubra: through after birth retained a pieces of placenta/membranes - 3-4 after birth: bleeding/ lochiainfection / Subinvolution 7.2 Quality (smell): Normal:like menstruation Abnormal:foul lochia => infection bad smell => no enough perineum care

11. 8. Bottom 8.1 Perineum: pain scale, healing of perineumCheck signs of infection by usingREEDA (Redness Edema Ecchymosis Discharge Approximation) 8.2 Genital organ : Edema, Hematoma, & Varicose vein 8.3 Rectum : Edema,Pain, Hemorrhange

12. 9.Bowel movement • normal labor • 2-3 after birth may constipation • abnormal labor perhapsNPO should observe Bowl movement before start oral foods

13. 10.Blues : Emotional status : Maternal role adaptation : Acceptance of infant & Social support : Bonding & Attachment Maternal behavior 1. Taking-in phase (dependent phase) : Dependent within 1-2 days 2. Taking-hold phase (dependent-independenr phase) : Dependent & Independent within10 days 3. Letting-go phase (independent phase) : Independent aboutDay10 after birth

14. 11. Baby : Head & Face : Skin, Chest, Abdomen & Back : Genital organ, Rectum : Extremities & movement : Vital signs : Sucking & Urination

15. 12. Bonding - Attachment between mother & baby - Observation attachment behavior : touch, hug, talk : eye contact, hold, feeding - Observationfamily adaptation - Sibling relationships

16. Thank You for Attention